Shohei Ohtani to the DL with UCL Injury

So, this seems bad….

Shohei Ohtani will be placed on the disabled list with a grade 2 sprain of the UCL. He underwent a PRP and Stem Cell injection yesterday with Dr. Steve Yoon in Los Angeles. He will be re-evaluated in 3 weeks and we will update his plan of care at that time.
— Los Angeles Angels (@Angels) June 8, 2018

After putting Shohei Ohtani on the DL this morning for what they were calling “blister problems” (a lie that has now been conveniently scrubbed from their social media sites), the Angels have grudging revealed that not only has Ohtani been placed on the DL for a sprained ulnar collateral ligament (UCL), but that he’s already received PRP and stem cell injections for it. Here’s a quick primer on what is happening.

What’s a Grade 2 UCL Sprain?

There are three grades of UCL injuries. Grade 1 is when the ligament is stretched but there’s no tearing involved, Grade 2 is when it’s stretched and there’s a partial tear, and Grade 3 is when the ligament is completely torn. With respect to ballplayers, Grade 3 UCL injuries are what brings about Tommy John surgeries and a year of rehab, but many pitchers will try to work through Grade 1 and 2 level injuries. Often, rehab is enough for a Grade 1. Grade 2 injuries, if rehab is unsuccessful and the pitcher continues to work, may graduate into full-blown surgical cases.

It had already been revealed last winter that Ohtani had been dealing with an UCL issue already, A week after Ohtani signed with the Angels this past December, Jeff Passan of Yahoo Sports reported that Ohtani had undergone PRP treatments last October for elbow pain. In November, Ohtani was diagnosed with a Grade 1 UCL sprain. It was not, at the time, considered serious, and that rehab would be enough to manage the issue.

What does PRP treatments do?

Platelet-rich plasma (PRP) treatments have become increasingly common since the days when Kobe Bryant had to fly to Germany to get one. In a PRP procedure , they take a vial of the patient’s blood, separate the platelets from the red and white blood cells, and then inject the platelet-heavy cocktail into the injured area. Platelets contain hundred of proteins called growth factors that are important to healing injuries. The idea is that concentrating the growth factors of the platelets in the injured area will speed up the healing process.

What does the Stem Cell procedure do? (Simplified version)

We’ve all seen the high school video where one cell become two, two become four, etc. That’s not EXACTLY what stem cells do, but it’s a useful visual. What’s important to know here is that stem cells have the ability to self-renew and proliferate— divide and divide and divide — almost indefinitely.

The second that’s important to know about stems cells is that they’re unspecialized. Your skin cells are your skin cells, and they’re never going to become anything else but more skin. Your skin cells are specialized. Stem cells are not, but they CAN BE. In fact, they can be used to create specialized cells, and that’s what makes them special. It’s a process called differentiation: stem cells can be triggered to proliferate — to divide and divide — and as they do, that next generation of stem cells become more specialized based on information triggered by a person’s DNA. In embryonic stem cells, the information in the cell DNA tells the cluster of stem cells what to grow — heart, brains, lungs, and so on. That’s how a mass of unspecified cells grow into the many specific parts that make up a human being.

In medical procedures using stem cells, instead of getting their programming from DNA, they get them from researchers. Using specific enzymes and proteins to trigger certain responses, researchers can direct stem cells to proliferate and differentiate in very specific directions. In Shohei Ohtani’s case, that direction is his UCL.

Does this stuff work?

It’s impossible to say at this point. There are no control groups for this type of orthobiologic procedures. In plowing through about a dozen medical journal articles relating to stem cell and PRP treatments when Garrett Richards‘ opted to do this, not one of them were willing to say definitively that their procedure is uniquely effective. Dodger reliever Takashi Saito, back in 2008, had a similar issue, went through a similar treatment, got shut down for two months, and then not only pitched that same season, but went on to have three more strong seasons before retiring at 42. Neal ElAttrache, the surgeon who worked with Saito, makes the point that nobody knows anything for sure. Said ElAttrache, “Maybe it was the injection. Or maybe it was that we shut him down and let him heal.” There just isn’t enough research for anyone to give a definitive answer.

Garret Richards went down with his UCL injury in May 2016. Between the stem cell therapy and the PRP cocktails injected into his elbow, Richards was throwing again by October of 2016… and we know that despite all that, Richards missed most of the next season with arm trouble that, the Angels claim, was not related to his UCL. Given the Angels’ shiftiness with regard to Richards’ injury, Matt Shoemaker’s injury and subsequent surgery, and now this morning with Ohtani, it’s impossible for an outsider to say just how true that is. It’s very possible even the Angels don’t know.

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That makes the Ohtani situation all the more touchy. All we know for sure right now is that his Grade 1 sprain has gotten worse. How much worse, and to what degree his Grade 2 tear is, has not been revealed. If Richards’ recovery time is any template, it could be a full year before Ohtani is back to being a rotation regular. On the other hand, if a 38-year-old Saito could come back strong in the same season, why not a 24-year-old Ohtani?

No one knows anything. For the time being, all anyone can do is wait, and hope.

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